The COVID-19 pandemic is a traumatic event for many, particularly those in the caring professions. Experts are predicting a significant “second curve” of mental health problems among both healthcare workers and the public related to prolonged social isolation, loss of economic opportunity, grief from losing loved ones, among other causes.
One recent study documented the negative impact of the pandemic on healthcare worker mental health, with a significant proportion of clinicians providing direct care to COVID-19 patients experiencing extraordinarily high rates of depression, anxiety, insomnia, and distress.
While there has been no shortage of resources and recommendations designed to help healthcare workers manage stress during the pandemic, there’s a tendency to place the burden on the individual. At a minimum, it is important that remedies acknowledge the shared responsibility of the healthcare system for creating the conditions for fear, anxiety, and burnout in the first place. Several recent publications illustrate what this can look like.
In an effort to streamline, provide sensemaking, and support care teams during this critical time, the Institute for Healthcare Improvement (IHI) synthesized themes from several key publications, expert interviews, and five years of experience gained by partnering with health systems around the world to address staff well-being and joy in work.
Three key areas to focus on have emerged, along with specific actions healthcare leaders can take to support their workforce and address the more immediate and longer-term effects of the pandemic.
Provide proactive support to manage fear and anxiety in daily work
Healthcare workers are experiencing significant fear and anxiety about their own health and well-being, particularly related to shortages of personal protective equipment. Concerns about personal health and safety are compounded by worries about infecting their own families. Some providers may be isolated from their families, disrupting social support networks and increasing loneliness, which is closely tied to poor mental health and substance use.
- Effective health system leaders should communicate updates to all staff honestly, transparently, and regularly to reduce the uncertainty staff may feel about their physical safety and how their employer is working to protect both staff and patients. Individual and small group conversations as well as wider staff updates are both important for building and maintaining trust.
- Provide staff training in new skills, particularly for those being redeployed to different work areas.
- As much as possible, provide adequate personal protective equipment, supplies and resources for staff to work safely. Communicate frequently regarding efforts to obtain more supplies as well as guidelines and best practices in their use.
- Provide financial and other support such as childcare and housing for staff and their families, should they need to be quarantined, by partnering with organizations looking to support caregivers such as hotels and Airbnb.
- Give staff more control over work patterns such as flexible scheduling and reducing the number of 12-hour shifts required during a crisis. This change should persist post-pandemic.
Ensure psychological safety and provide opt-out mental health and well-being support
During the COVID-19 pandemic, healthcare workers are experiencing moral injury, defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
Research indicates that moral injury is a significant contributor to trauma and likely affects each healthcare worker in some way during the pandemic. This can be exacerbated in environments of low psychological safety where individuals may not feel safe speaking up about risks or discussing fears openly.
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Health system leaders can establish psychological safety (or reduce the risk for psychological trauma) for the healthcare workforce in several ways:
- Communicate to staff that their mental health and well-being is vitally important. Senior leaders can make significant inroads in changing perceptions of mental health and reducing stigma by speaking openly about their own experiences and the organization’s desire to actively help.
- Create opportunities to hear directly from staff about their needs and suggestions for how the organization can better support mental health and well-being, including providing opportunities to co-create changes and real-time solutions in partnership with staff.
- Provide space and time to educate staff about mental health issues specific to the COVID-19 crisis, to call out the pervasive and common culture of infallibility and the risks this poses, and to engage the healthcare provider community.
- Create access to mental health support or treatment for all staff. Consider opt-out rather than opt-in support to more proactively assist staff with identified mental health and substance use disorders and ensure that all staff who want and need mental health support are able to receive it quickly.
Create opportunities for staff to reconnect to meaning and purpose in their work
Changes to team structure, roles, and social connections and supports with colleagues add uncertainty and additional strain on healthcare workers. Team members are being asked to serve in new and different roles that are changing constantly. Typical outlets for socializing and connecting have been eliminated due to infection concerns.
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Managing this uncertainty, combined with the risk of moral injury and fear and anxiety for their own safety, is creating a potential wave of trauma that will affect healthcare workers for years to come.
There are several strategies leaders can use to help staff reconnect to meaning and purpose:
- Intentionally facilitate peer-to-peer connections and support such as the Center for Medical Simulation’s Talk2Support Program.
- Create opportunities for reflection, for example, by engaging staff in regular Moral Resilience Rounds such as those offered at Johns Hopkins University.
- Provide proactive support for physical and emotional space to enable staff to take a break and reset, such as “well-being suites” that have showers and snacks and opportunities to exercise.
While the COVID-19 pandemic will remain with us in various forms to various degrees for a long time, strategies that can benefit staff during a pandemic can also help over the long term. Workforce mental health and well-being has been a serious and growing problem for quite some time. There has never been a more appropriate and opportune moment to lean into these issues.
Mara Laderman is a senior director and Jessica Perlo is a director for the Institute for Healthcare Improvement, a nonprofit dedicated to improving health and healthcare worldwide.